Senators sponsoring a last-ditch Obamacare repeal bill raced to save it fromnear-certain death Sunday, circulating a new version aimed atwinning over several GOP holdouts.

Some of the changes,which come as Republicans face a Sept. 30 deadline to pass themeasure, were designed to appeal to moderate holdouts like LisaMurkowski of Alaska, while others appeared tailored to lureconservative skeptics like Rand Paul of Kentucky.

But with several senators expressing severe doubts or outright opposition to the version releasedlast week, it’s unclear that the revisions will win enough supportto resuscitate the repeal effort.

Related: Jimmy Kimmel rips into GOP health bill forfailing ‘Kimmel Test’

If Republicans can’t get the votes -- or decide to scrap thisbill altogether -- it would mark another reminder of the party’sinability to deliver on seven years of promises to repeal the 2010law.

The GOP could still tryto resurrect a proposal later in the year, but the repeal effort’scollapse would seed doubts about the party’s ability to deliver anysignificant legislative victories.

On Sunday, even President Donald Trump seemed to concede thatthe outlook isn’t rosy for repeal. Asked by reporters about thehealth-care bill, he replied, “Eventually we will win on that. Myprimary focus, I must tell you -- has been from the beginning, asyou can imagine -- is taxes.”

Targeting key states

The new version, which could be discussed at a Senate Financehearing scheduled for Monday afternoon, directs some additionalfunding to key states, including multiple provisions directing moremoney to Murkowski’s Alaska.

The revised bill also changes language regarding pre-existingconditions, which has been one of several flashpoints in themeasure authored by Republicans Lindsey Graham of South Carolinaand Bill Cassidy of Louisiana.

Under the revised version, states would have to describe howtheir health plans "shall maintain access to adequate andaffordable health insurance coverage for individuals withpre-existing conditions." The original language said each state hadto show how it "intends" to have adequate and affordable access tocoverage.

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The bill continues, however, to give states broad new authorityto allow insurance companies to provide skimpier plans with farfewer benefits while charging higher premiums to the sick and theold.

Under the new version, states could let insurers imposedeductibles that are higher than the limits set by the AffordableCare Act, or remove the health law’s limits on the costs that anindividual family can incur in a year entirely. They could alsooffer coverage that lacks some of the ACA’s benefits, such asmaternity care, prescription drugs or mental health. Plus, statescould let insurers widen the gap between how much old people andyoung people are charged. And states could remove requirements thatinsurers cover preventive-health treatments and immunizations.

Democrats swiftly criticized the latest version.

“Despite an attempt to appear to add money for a select fewstates, this bill is just as bad for those states and the rest ofthe states because it still contains a massive cut to Medicaid, andwould throw our health insurance system into chaos while raisingpremiums,” Senate Minority Leader Chuck Schumer of New York said ina statement late Sunday.

“No last-minute changes can disguise the fundamentally rottenconsequences of Trumpcare,” House Minority Leader Nancy Pelosi ofCalifornia said in a statement Monday. “Republicans must stopmaking a dangerous bill even worse and join Democrats forconstructive bipartisan progress to improve and update Americans’health care.”

McCain’s ‘conscience’

The GOP’s hopes for repealing Obamacare were largely dashed onFriday, when Republican Senator John McCain came out againstthe last-ditch repeal bill.

“I cannot in good conscience vote for the Graham-Cassidyproposal,” McCain of Arizona said in a statement. “I believe wecould do better working together, Republicans and Democrats, andhave not yet really tried.”

McCain joined Paul in opposing the bill, while Susan Collins ofMaine said Sunday she doesn’t see herself backing the bill. “It’svery difficult for me to envision a scenario where I end up votingfor this bill,” Collins said on CNN’s “State of the Union.” “I havea number of serious reservations about it.”

Murkowski, who voted against previous repeal measures, is alsoundecided. Ted Cruz of Texas said Sunday he doesn’t back thebill in its current form, and a few other senators have been silenton their positions including Mike Lee of Utah, Rob Portman of Ohioand Shelley Moore Capito of West Virginia. Senate Republicans canafford to lose no more than two members of their 52-48 majority andpass the bill.

United opposition

The bill provoked an unusually strong backlash from the health-careindustry as well. Groups representing doctors, hospitals andinsurers signed a letter Saturday urging the Senate to reject theGraham-Cassidy bill.

The groups said the bill would undermine protections forpatients with pre-existing conditions, result in dramatic cuts toMedicaid and “drastically” weaken the individual insurance markets.The letter was signed by the American Medical Association,the American Academy of Family Physicians, the AmericanHospital Association, and America’s Health Insurance Plans,which represents major insurers

The expected failure of this effort would mean that Republicanefforts to pass a standalone Obamacare repeal are effectivelydead, since the fast-track mechanism known as reconciliationthat would allow the GOP to pass a measure with only 50 votesexpires Sept. 30.

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There are, however, a few scenarios for the GOP to revisithealth care later in the year. Republicans are planning to adopt anew budget resolution in the fall that would unlock reconciliationfor their plan for a tax overhaul. That resolution is expected toallow room for Obamacare repeal provisions, although trying tocombine the two complicated policies might make the overall packageeven harder to pass.

‘Not easy’

Senate Finance Chairman Orrin Hatch of Utah said last week thatthere’s a “chance” of pairing taxes with health-care provisions.“But it’s not easy,” he added.

Senate Majority Leader Mitch McConnell of Kentucky still has todecide whether to go through with a vote, which would likely happenWednesday. While Trump has urged GOP leaders to make every possibleeffort to repeal Obamacare, some Republicans will be reluctant totake a vote on a bill that many privately are uncomfortablewith.

The nonpartisan Congressional Budget Office will release apartial analysis of the Graham-Cassidy proposal as early asMonday. It will examine the proposal’s impact on the federaldeficit, but a full review of the effect on U.S. health coverageand costs won’t be ready for weeks.

The Senate Finance Committee will hold the only hearing on thebill Monday afternoon, and it doesn’t plan to vote on the measure.Senate Republicans will have a private lunchtime meeting Tuesday,where GOP leaders can make a last plea for support.

If Republicans go ahead with a vote, it could die a ratherunceremonious death. There could be essentially no debate on theSenate floor because the Graham-Cassidy bill is being grafted ontoMcConnell’s previous bill -- and the time for debate on thatmeasure expired in July.

The Graham-Cassidy bill would turn the money that fundsObamacare into block grants for the states, which would createtheir own health-care plans for their residents. States thatexpanded Medicaid under Obamacare would be hardest hit, losing $180billion from 2020 to 2026, according to the Kaiser FamilyFoundation, which studied an earlier version of the bill. Statesthat rejected the Medicaid expansion would gain $73 billion. Thebill changes how Medicaid is funded from a fixed percentageregardless of total spending to a per-enrollee cost.

The bill also would end the Affordable Care Act’s requirementsthat individuals have insurance and that most employers provide it,and leave most Obamacare tax increases intact.

21 million fewer insured

The Brookings Institution estimated Friday that theGraham-Cassidy plan would reduce the number of people with healthcoverage by about 21 million a year from 2020 through 2026.

Schumer praised McCain for his opposition in a statement Fridayand said, “I have assured Senator McCain that as soon as repeal isoff the table, we Democrats are intent on resuming the bipartisanprocess.”

After the July defeat of McConnell’s plan, Senate HealthChairman Lamar Alexander and top Democrat Patty Murray ofWashington worked on a bipartisan plan to shore up Obamacare’sinsurance exchanges, but Alexander of Tennessee said last week thatthe effort had failed. Murray said in a statement, though, thatthey “identified significant common ground” but GOP leaders decidedto “freeze” the bipartisan effort and push the party’s ownplan.

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